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April 10, 2026Health Affairs ScholarOpen Access

Payer Mix Shifts and Profitability at Critical Access Hospitals, 2011 to 2023

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Authors

YJYusheng JiaYLYiming LiXCXueya Cai

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Overview

Analysis reveals payer mix shifts influence profit margins in critical access hospitals, indicating financial challenges ahead.

Key Points

  • To examine how changes in payer mix impact profit margins in critical access hospitals (CAHs) between 2011 and 2023.
  • Analyzed 15,819 hospital-year observations from 1,384 critical access hospitals.
  • Utilized data from the National Academy for State Health Policy Hospital Cost Tool and the American Hospital Association.
  • Estimated multivariable linear mixed-effects models with profit margin as the dependent variable.
  • Considered four payer categories: Commercial, Medicare, Medicaid, and Uncompensated Care.
  • A one percentage point increase in Medicare payer mix was linked to a 0.10 percentage point increase in overall operating margin.
  • A one percentage point increase in Medicaid payer mix was linked to a 0.09 percentage point increase in overall operating margin.
  • Higher mixes of Medicare, Medicaid, and Uncompensated Care were associated with improved Commercial profit margins.

Cite This Study

Jia et al. (2026) studied this question.

synapsesocial.com/papers/69d895d86c1944d70ce06e6dhttps://doi.org/10.1093/haschl/qxag083
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